1336367739 NPI number — MR. JACK ONEIL RPT

Table of content: MR. JACK ONEIL RPT (NPI 1336367739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336367739 NPI number — MR. JACK ONEIL RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ONEIL
Provider First Name:
JACK
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336367739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15739 PROFESSIONAL PLAZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70403-1452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-345-6000
Provider Business Mailing Address Fax Number:
985-345-4498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15739 PROFESSIONAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-345-6000
Provider Business Practice Location Address Fax Number:
985-345-4498
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  00095 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1449819 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 32005900 . This is a "ACS OWCP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 11655 . This is a "BCBS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 06552 . This is a "BCBS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 720678856 . This is a "OGB" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 5716136 . This is a "FIRST HEALTH" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 684200 . This is a "ACN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 684200 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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